不明发病时间急性缺血性脑卒中于 CTP 指导下溶栓治疗效果观察

摘要

目的：探讨CT灌注成像（ CTP）检查指导治疗不明发病时间急性缺血性脑卒中的有效性和安全性。方法选取发病时间不明急性缺血性脑卒中患者，经患者或家属签署知情同意书后行CTP检查，发现存在缺血半暗带（CTP组）72例，进行重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗；同时将发病时间小于4．5 h的80例脑梗死患者作为溶栓对照（对照组）。记录两组溶栓前、溶栓后2 h、24 h、14 d、30 d的NIHSS评分及溶栓后30 d的Bar-thel指数及改良Rankin量表（ mRS）评分，监测不良反应；分别检测两组溶栓前、溶栓后24 h、14 d时血清MMP-9。结果 CTP组rt-PA静脉溶栓后各时间段NIHSS评分与治疗前相比均有明显改善（P均＜0．05），而对照组NIHSS评分于溶栓后14、30 d明显降低（P＜0．05）。与溶栓前相比，两组患者mRS评分均显著改善（ P＜0．05），两组间mRS评分比较，P﹥0．05；两组患者Barthel指数均显著改善（P均＜0．05），两组Barthel指数评分比较，P﹥0．05。两组患者溶栓前、溶栓后24 h血清MMP-9水平比较，P均﹥0．05，14 d时CTP组血清MMP-9水平明显低于对照组（P＜0．05）。两组溶栓后患者血尿便常规、凝血及肝肾功能检查结果大致正常，均未发生颅内出血、再闭塞。结论对不明发病时间急性缺血性脑卒中患者，经CTP检查见缺血半暗带者应用rt-PA溶栓治疗安全有效。%Objective To evaluate the efficacy and safety of CT perfusion ( CTP)-based thrombolytic therapy in acute ischemic stroke patients with unclear onset time.Methods The acute ischemic stroke patients with unclear onset time were selected.After patients or relatives signed the informed consent, they were scanned by CTP.Seventy-two patients with ischemic penumbra received intravenous thrombolysis of recombinant tissue plasminogen activator ( rt-PA) ( CTP group) , and at the same time, the cerebral infarction patients whose onset time was within 4.5 h were enrolled as thrombolysis-con-trol group (control group, 80 cases).The NIHSS was recorded before,and 2 hours, 24 hours, 14 days and 30 days after thrombolytic therapy.The Barthel index ( BI) and modified Rankin scale( mRs) score were recorded before thrombolysis and 30 days after thrombolysis.CT was also re-examined 24 h after thrombolysis, and the adverse reactions were moni-tored.The level of matrix metalloproteinase 9 (MMP-9) was detected in the two groups before, 24 hours and 14 days after thrombolytic therapy.Results NIHSS scores were improved at different time points in the CTP group after the rt-PA intra-venous thrombolysis as compared with those before treatment, and significant difference was observed (all P<0.05).In contrast, no significant change of the NIHSS score was observed in the control group at 24 hours, and it significantly im-proved until 14 days and 30 days after treatment (P<0.05).No significant difference was found in the NIHSS score be-tween the CTP group and the control group 24 h after treatment (P﹥0.05).The mRs score was significantly improved in the two groups as compared with before treatment (P<0.05), but there was no significant difference in the mRs score be-tween the two groups (P>0.05).The Barthel index was significantly improved in the two groups (all P<0.05), but there was no significant difference in the Barthel index between the two groups (P>0.05).There was no significant differ-ence in the MMP-9 level before treatment and 24 hours after treatment between the two groups (P﹥0.05).At day 14, the MMP-9 level in the CPT group was significantly lower than that of the control group (P<0.05).The examinations of blood routine, urine routine and stool routine were normal, and the intracranial hemorrhage and blocking were not seen. Conclusions For unclear-onset acute ischemic stroke patients with ischemic penumbra after CTP examination, the rt-PA intravenous thrombolysis is safe and effective.